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Management of Swallowing and Communication difficulties in Down Syndrome: A survey of SLP 

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RESOURCES

Sections for before and after laryngectomy surgery, Symptoms, treatments, and side effects are covered. Links are provided to otolaryngology centers and other reliable sources for additional information and support.

Readers interested in reprinting an article from any part of our library and/or newsletters for use in another newsletter, handout, or for any other noncommercial purpose are welcome to do so after requesting and receiving permission to reprint, which should be requested from the Editors at editor@webwhispers.org. At a minimum, the reprinted article should be credited to the original author (if known) and to the section of the WebWhispers library from which it was copied or the edition of the publication from which it was copied.

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WebWhispers | Laryngectomy Survivors Support Group

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Web Whispers is the largest support group for laryngectomee survivors of larynx and other throat cancers, offering education and advice when it's needed.

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You qualify for hospice care if you have Medicare Part A (Hospital Insurance) and meet all of these conditions:

Your hospice doctor and your regular doctor (if you have one) certify that you're terminally ill (with a life expectancy of 6 months or less).

You accept comfort care (palliative care) instead of care to cure your illness.

You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

You can usually get Medicare-certified hospice care in your home or other facility where you live, like a nursing home. You can also get hospice care in an inpatient hospice facility.

Your costs in Original Medicare

You pay nothing for hospice care.

You pay a copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management. In the rare case the hospice benefit doesn't cover your drug, your hospice provider should contact your plan to see if Part D covers it. The hospice provider will inform you if any drugs or services aren't covered, and if you'll be required to pay for them.

You may pay 5% of the Medicare-approved amount for inpatient respite care. Your copay can't exceed the inpatient hospital deductible for the year.

Original Medicare will still pay for covered benefits for any health problems that aren't part of your terminal illness and related conditions, but this is unusual. Once you choose hospice care, your hospice benefit will usually cover everything you need.

You may have to pay for room and board if you live in a facility (like a nursing home) and choose to get hospice care.

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you'll owe may depend on several things, like:

Other insurance you may have

How much your doctor charges

If your doctor accepts assignment

The type of facility

Where you get your test, item, or service

What it is

Depending on your terminal illness and related conditions, your hospice team will create a plan of care that can include any or all of these services:

Doctors' services.

Nursing and medical services.

Durable medical equipment for pain relief and symptom management.

Medical supplies, like bandages or catheters.

Drugs for pain and symptom management.

Aide and homemaker services.

Physical therapy services.

Occupational therapy services.

Speech-language pathology services.

Social services.

Dietary counseling.

Spiritual and grief counseling for you and your family.

Short-term inpatient care for pain and symptom management.

Inpatient respite care , which is care you get in a Medicare-approved facility (like an inpatient facility, hospital, or nursing home), so that your usual caregiver (like a family member or friend) can rest. Your hospice provider will arrange this for you. You can stay up to 5 days each time you get respite care. You can get respite care more than once, but only on an occasional basis.

Any other services Medicare covers to manage your pain and other symptoms related to your terminal illness and related conditions, as your hospice team recommends.

Things to know

Only your hospice doctor and your regular doctor (if you have one) can certify that you're terminally ill and have a life expectancy of 6 months or less. After 6 months, you can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies (at a face-to-face meeting) that you're still terminally ill.

Medicare won't cover any of these once your hospice benefit starts:

Treatment intended to cure your terminal illness and/or related conditions. Talk with your doctor if you're thinking about getting treatment to cure your illness. As a hospice patient, you always have the right to stop hospice care at any time.

Prescription drugs to cure your illness (rather than for symptom control or pain relief).

Care from any hospice provider that wasn't set up by the hospice medical team. You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can't get the same type of hospice care from a different hospice, unless you change your hospice provider. However, you can still see your regular doctor or nurse practitioner if you've chosen him or her to be the attending medical professional who helps supervise your hospice care.

Room and board. Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.

Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation, unless it's either arranged by your hospice team or is unrelated to your terminal illness and related conditions.

Contact your hospice team before you get any of these services or you might have to pay the entire cost.

Is my test, item, or service covered?

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Have terminal illness or know someone who does? Get hospice care coverage. Choose between in home, inpatient facility care. Learn more at Medicare.

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Facing an inevitable outcome, terminally ill patients meet extraordinary medical practitioners seeking to change our approach to life and death.

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BJ Miller: What really matters at the end of life | TED Talk

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At the end of our lives, what do we most wish for? For many, it’s simply comfort, respect, love. BJ Miller is a hospice and palliative medicine physician who thinks deeply about how to create a dignified, graceful end of life for his patients. Take the time to savor this moving talk, which asks big…

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Nursing requires hands-on training. But research has found that university curriculum often goes light on one of life's universal experiences - dying. So some colleges have gone to new lengths to make the training more meaningful.

There's a sound near the end - the death rattle. People stop swallowing. The lungs fill up. There can be involuntary moaning.

"So you get all that noise. And that's really distressing for family members," Professor Sara Camp of Nashville's Belmont University says.

Camp and other nursing instructors at Belmont wear headsets and watch video monitors in a dark closet. The sounds they make emerge from realistic robots lying in hospital beds on the other side of the wall. The instructors also control the stats for the robots' breathing, pulse and blood pressure.

Other than administering morphine, there's no exact prescription for students to follow. A review of nursing textbooks found many make no mention of this standard part of the job. And studies of professional nurses find thatmany feel unprepared.

"They're really comfortable in their skills, like putting in IVs and giving medications," Camps says. "In this one, they have to focus on communication, when there's not that much to do. It challenges them."

There are family dynamics to navigate, like explaining to grown children how their mother signed a do-not-resuscitate order. They have to balance caring for the dying patient and attending to the patient'sfamily.

In response to surveys showing anxiety about death among young nurses, Belmont started hiring actors to make these end-of-life interactions as realistic as possible.

"That old cancer ... didn't want it to come back," says Vickie Bailey, who has embraced her role as a grieving daughter.

The student, senior Sara Lindsay, sits on the bedside and puts a hand on Bailey, warning that the end is near.

"Now would be a good time if you have prayers or anything you want to say," she tells Bailey.

"I've been praying all morning," Bailey responds, in character.

The monitors stop beeping. Everyone sits in silence.

Once the simulation ends, Lindsay marvels at how real the moment felt.

Half a dozen beds are going at the same time in this simulation lab. And all the students gather to debrief afterward. Senior Zacnite Vargas volunteers that she second-guessed herself.

"Should I say she's dying? She's dead? She's passed?" she asks. "I don't know how to be straight-forward with it."

Camp tells the class to be cautious, especially about predicting when a patient will die, but also show compassion.

"They may not remember what you say, but they'll remember how they feel when you were there, because you were there."

It's such important work, Camp says, that more students should get the chance to rehearse.

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Morphine, And A Side Of Grief Counseling: Nursing Students Learn How To Handle Death

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Research has found that university curriculum often goes light on one of life's universal experiences - dying. So some colleges have gone to new lengths to make the training more meaningful.

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Are You Ready for a Glorious Sunset? - Freakonomics

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Are You Ready for a Glorious Sunset? - Freakonomics

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Witness the wrenching emotions that accompany end-of-life decisions as doctors, patients and families in a hospital ICU face harrowing choices. Watch trailers & learn more.

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health Care Navigation and Self-care Tasks

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Health Literacy and Provider Communciation

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Enhancing Communication in Hospice Settings

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10 common dysphagia treatment pitfalls to avoid

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Standardization of Dysphagia Diets: A Model of Successful International Engagement

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The Neonatal Therapy National Certification ® Board (NTNCB) is a multidisciplinary board comprised of occupational therapists, physical therapists, and speech-language pathologists who have expertise in neonatal intensive care units (NICUs) throughout the United States and around the world. The NTNCB provides certification to neonatal therapists who have demonstrated the time, knowledge, and commitment to serve high-risk infants in the NICU.

What is a Certified Neonatal Therapist?

The Certified Neonatal Therapist (CNT) has demonstrated the experience and knowledge to work safely and effectively with high-risk infants in the NICU using evidence-based practice. CNTs have met minimum standards of 3 years as a credentialed professional, 3500 hours of practice in the NICU, 40 hours of NICU-related education, and a minimum of 40 hours of mentoring, followed by achieving a passing score on the Neonatal Therapy National Certification Exam. Congratulations on fulfilling the basic requirements for becoming a CNT and embarking on the final step, the exam.

Non-Disclosure Agreement

You will be required to affirm that you have read and accept the terms of the NTNCB Non-Disclosure Agreement onscreen prior to beginning your exam. The agreement reads: " I will not disclose or provide to anyone orally, electronically, or in any other format, information about the content of this examination. I understand that all documents and examination questions are, and shall remain, the exclusive property of NTNCB. " If you do not accept these terms, then you will not be allowed to take the exam.

Exam Scheduling Information

Eligibility

You must apply for neonatal therapy certification with the NTNCB prior to being authorized to take this examination. Visit https://ntncb.com/certification-requirements/ to find the applicant checklist and instructions.

Scheduling

You have 6 months from the date of notification of eligibility to take the exam. You will need to schedule your exam at least 72 hours in advance and, should you wish to cancel or reschedule, you must contact Pearson VUE no less than 72 hours in advance of your scheduled appointment.

Computer-Based Testing Tutorial and Practice Exam

You may obtain general information about computer-based testing, answers to FAQ, as well as practice taking a general exam using the computer by clicking here.

**Please note that the NTNCB uses solely multiple choice formats with 4 answer choices.

More Details about the Neonatal Therapy National Certification Exam

Please refer to the exam manual on the NTNCB website for more exam details.

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neonatal therapy national certification board

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Neonatal Therapy National Certification Board (NTNCB) :: Pearson VUE

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The Neonatal Therapy National Certification Board (NTNCB) is a multidisciplinary board comprised of occupational therapists, physical therapists, and speech-language pathologists who have expertise in neonatal intensive care units (NICUs) throughout the United States and around the world.

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inflation and Deflation of Cuffed Trach Tube 

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Appendix E Some Laboratory Tests of Clinical Importance

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Centers for Disease Control and Prevention

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The CDC Clear Communication Index (Index) is a research-based tool to help you develop and assess public communication materials.

The Index has 4 introductory questions and 20 scored items drawn from scientific literature in communication and related disciplines.

The items represent the most important characteristics that enhance and aid people's understanding of information.

Everyday Words for Public Health Communication offers expert recommendations from CDC's Health Literacy Council and other agency communicators on how to reduce jargon and replace problematic terms in your materials in order to improve your audience's comprehension.

We've provided a few examples of the materials we tested with descriptions of what we changed.

Healthcare-associated Infections

National Violent Death Reporting System

Thimerosal

Copy the below code into your site to add the Index Widget

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Learn how to make information easier for the public to understand, including for adults with intellectual & developmental disabilities & extreme low literacy

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When you're studying the muscular system, there's a lot of terminology to learn beyond the names of the muscles themselves. Part of becoming familiar with the body's muscles is learning how to describe the locations where they attach to bones, the different kinds of muscle actions that move the body, and what roles muscles play in different movements.

Video footage from Muscles & Kinesiology.

Today, we're going to explore the basics of this terminology using the newest version of our musculoskeletal app for iOS- Muscles & Kinesiology!

What are origins and insertions?

The majority of skeletal muscles wouldn't be very useful to us if they weren't attached to bones-we are able to move our bodies precisely because the muscular and skeletal systems are literally linked to one another.

When skeletal muscles receive electrical signals from the nervous system, they contract, and the force generated by that contraction moves bones relative to the joints that connect them. Essentially, bones act as levers and synovial joints act as fulcrums. The force it takes to move the lever is applied by the contraction of a muscle or series of muscles working together.

Tendons are strong, thick bands of connective tissue that attach muscles to bones. There are two different classifications of skeletal muscle attachment points: origins and insertions. The origin is the location where a muscle attaches to a fixed (or stabilized) bone with respect to the joint the muscle is acting on. The location where the muscle attaches to the bone that is moved by the contraction of the muscle is called the insertion.

It's frequently the case that one muscle has multiple points of attachment. Take the biceps brachii as an example. Its two heads have different points of origin on the scapula-the long head's origin is the supraglenoid tubercle, and the short head's origin is the coracoid process. The point of insertion for both heads of the biceps brachii is the radial tuberosity on the radius bone of the forearm. When muscle fibers in the biceps brachii (and the other muscles it works with) contract, the forearm is pulled towards the upper arm and shoulder joint.

Image from The origin (red pin) and insertion (blue pin) of the long head of the biceps brachii. Muscles & Kinesiology.

Studying origins and insertions with Muscles & Kinesiology

Muscles & Kinesiology makes it easy to visualize origins and insertions using pins and bone paint. This is a great tool for people like me, who use colors to memorize everything!

Let's say you want to look at the attachments for the latissimus dorsi (lats!). First, choose a regional view that contains the latissimus dorsi-like shoulder extension-or select the latissimus dorsi from the muscle index. Fun fact: if you know what muscle you're looking for, you can type its name into the search box below the menu at the top of the screen.

The Muscle Index and search bar in Muscles & Kinesiology.

Once you've got the 3D model on the screen, tap or click the latissimus dorsi to highlight it. In the info box, you'll see a red pin icon-tap it and you'll be taken to the pins and paint view, where you can explore the origins and insertions of the latissimus dorsi by tapping the red and blue pins you see on the model. You can also move through them quickly by tapping the arrow icons on the pin label, as I do in the video below.

The attachments of the latissimus dorsi. Video footage from Muscles & Kinesiology.

What are the roles muscles play during muscle actions?

In any muscle action, there are several key players. The first, and arguably the most important, is the role of agonist, or prime mover. An agonist is a muscle that does the bulk of the work during a muscle action. There can be multiple agonists working together, as well. For an example, think back to the biceps brachii. It's a prime mover in elbow flexion, along with the brachialis and brachioradialis.

In literature, an antagonist works against the hero and stands in the way of their goals. A muscle working as an antagonist does something similar: it works in opposition to the action of the agonist. In fact, it's usually a prime mover of the opposite action in a pair like flexion and extension (more on those later). Why is it important to have an antagonist? They help maintain the position of the body or limb during muscle actions, and they also keep muscle movements controlled.

In the elbow example, the triceps brachii would be the antagonist for elbow flexion, but it's the agonist for the opposing action, elbow extension. The hamstrings and quadriceps femoris muscle groups have a similar agonist/antagonist relationship for the flexion and extension of the knee joint.

Now, sometimes agonists need a little help. This is where synergists and stabilizers come in. Synergists provide direct assistance to the agonists. For example, the pronator teres is a synergist in elbow flexion. Stabilizers help the agonist by stabilizing the bone that the prime mover's origin attaches to (that is, the bone that's not being moved).

The pronator teres acts as a synergist in elbow flexion. Image from Muscles & Kinesiology.

Using Muscles & Kinesiology to study muscle roles and interactions

To see which actions a particular muscle is involved in, select that muscle and read the definition of that muscle in the info box.

You can also select a muscle action and check the info box to see which muscles act as prime movers and synergists in that action. Then you can select individual muscles to find out more about them.

The info box for scapula elevation in Muscles & Kinesiology.

What are the different types of muscle actions?

Although we've started by talking about flexion and extension, there's a lot more to muscle actions than just those two! Let's take a look at the different types of paired muscle actions you can explore in Muscles & Kinesiology.
Abduction and adduction
Abduction and adduction occur at ball-and-socket joints like the shoulder and hip. Thinking about the midline of the body and the meaning of Latin prepositions-turned-prefixes are key to remembering the difference between these two movements. ABduction is movement away from the midline of the body (in Latin, the preposition a/ab roughly means "from").

Hip abduction.

ADduction is movement towards the midline of the body (ad is another Latin preposition which means "to" or "toward").

Hip adduction.

Elevation and depression
Elevation and depression are what they sound like: moving a part of the body up or down. The most obvious example of these actions is the elevation and depression of the mandible, which closes and opens the mouth, respectively. The scapulae can also be moved in this way-think of a shoulder shrug and you've got scapula elevation.

Scapula elevation.

Pressing the shoulder(s) down is scapula depression.

Scapula depression.
Flexion and extension
The technical definition of flexion and extension has to do with the angle between two bones. A movement that decreases the angle between bones is flexion.

Knee flexion.

A movement that increases the angle between bones is extension.

Knee extension.

Flexion and extension occur at hinge joints like the knee, elbow, and digits; ball-and-socket joints like the shoulder and hip; and gliding joints in the spine. Lateral flexion (right-left direction of movement vs. forward-backward) also occurs in the joints of the spine.
Inversion and eversion
Inversion and eversion, like abduction and adduction, make reference to the midline of the body. Turning the sole of the foot inward (towards the midline) is inversion.

Foot inversion.

Turning the sole of the foot outward (away from the midline) is eversion. Once again, you can see this in the prefixes-in Latin, the preposition in means "into" or "against," and e/ex means "from" or "out from."

Foot eversion.
Plantarflexion and dorsiflexion
The trick to remembering the difference between plantarflexion and dorsiflexion is thinking about which part of the foot is decreasing its angle with respect to the leg.

Plantarflexion deals with the sole of the foot (the plantar surface). The angle between the sole of the foot and the calf decreases-think of this as bringing that angle from 270° to 180°.

Plantarflexion.

Dorsiflexion is when the foot moves such that the toes come closer to the shin. That is to say, the angle between the top of the foot (dorsum) and the shin decreases.

Dorsiflexion.
Pronation & supination
With pronation and supination, it helps to think about the prone and supine positions of the body. A prone position is one in which a person is lying stomach and face down, and a supine position is one in which a person is lying stomach and face up. If we think about pronation and supination of the forearm as if the palm of the hand is the stomach, pronation would be a rotation of the forearm ending with the palm facing backward or down.

Forearm pronation.

Supination would be a rotation of the forearm ending with the palm facing forward or up.

Forearm supination.
Protraction and retraction
Protraction and retraction are also pretty much what they sound like. They involve moving a part of the body forward (protraction) or backward (retraction). In addition to being moved up and down, the mandible can also be moved forward or backward. When the mandible moves forward, ending in an underbite, that's mandible protraction.

Mandible protraction.

When the mandible moves backwards, ending in an overbite, that's mandible retraction.

Mandible retraction.

Studying muscle actions in Muscles & Kinesiology

With its muscle actions menu, enhanced muscle action animations, and related content options, Muscles & Kinesiology makes it easy to integrate muscle actions into your studies!

You can view the full library of muscle action animations by looking at the muscle actions menu. Within the menu, the actions are organized by body region.

The muscle actions menu in Muscles & Kinesiology.

As you've seen in the video clips above, the new muscle action animations in Muscles & Kinesiology (as well as the newest version of Human Anatomy Atlas) feature fading as the muscles involved in an action relax. This fading makes it easier to distinguish between paired actions.

Let's look at scapula elevation and depression as an example. First, we'll go to the muscle actions menu and look in the shoulder section. We'll select scapula elevation, and then watch the animation and take a look at the info box.

From here, there are two ways you can get to the scapula depression animation-you can either return to the muscle actions menu by tapping the icon in the lower left hand corner of the screen, or you can select the scapula depression animation from the Related Content section of the info box.

Selecting an animation from the Related Content in Muscles & Kinesiology.

All in all, Muscles & Kinesiology ( available now for iOS and coming soon to Android!) gives you the tools you need to study how muscles move, how they interact with one another, and where they attach to the skeleton.

You can also visit the Visible Body Learn Site and check out these related blog posts to learn more about how the muscular, nervous, and skeletal systems interact and what happens when injuries occur:

Be sure to subscribe to the Visible BodyBlog for more anatomy awesomeness!

Are you an instructor? We have award-winning 3D products and resources for your anatomy and physiology course! Learn more here.

Additional Sources:

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A Visual Guide to Muscle Terminology with Muscles & Kinesiology

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We're going to explore the basics of muscle attachments and actions using the newest version of our musculoskeletal app for iOS-Muscles & Kinesiology!

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Anatomy & Physiology of Swallowing -- MBSImP Animations

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The 4 Stages of Swallowing: Biomechanics & Bolus Movement

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Prevalence and Characteristics of Dysphagia Based on a Population-Based Survey 

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The Global prevalence of oropharyngeal dysphagia in different populations: a systematic review and meta analysis 